Meningeal syndrome is a set of symptoms indicating a disorder in the meninges (membranes that surround the brain and spinal cord). Its three main symptoms are headache, vomiting and stiff neck. Meningeal syndrome is a medical emergency.

Definition of meningeal syndrome

The meninges are protective layers for the central nervous system. They are a trio of successive membranes covering the brain in the cranial cavity and the spinal cord in the spinal cavity (spine).

We speak of meningeal syndrome to designate a set of symptoms indicating suffering of the meninges. This syndrome is mainly marked by three symptoms:

• headaches (headaches),
• vomiting
• stiffness and muscle pain in the neck.

Other symptoms are frequently observed (see the “Symptoms” section of this sheet). In the slightest doubt, medical advice is essential. Meningeal syndrome requires systematic and urgent care.

Causes of meningeal syndrome

Meningeal syndrome manifests itself in meningitis (inflammation of the meninges) and subarachnoid hemorrhages (eruption of blood in the meninges). Their causes are different.

In the vast majority of cases, subarachnoid hemorrhage is due to a crack or rupture of an intracranial aneurysm (a kind of hernia that forms on the wall of the arteries). Meningitis is mainly due to a viral or bacterial infection. Meningoencephalitis is sometimes seen when the inflammation affects the meninges and the brain they cover.

Note: There is sometimes confusion between meningeal syndrome and meningitis. Meningeal syndrome is the set of symptoms that can occur in meningitis. On the other hand, a meningeal syndrome can have other causes than meningitis.

Persons concerned

Meningitis can occur at any age. However, the risk is higher in:

• children under 2 years old;
• adolescents and young adults aged 18 to 24;
• people with a weakened immune system, which includes the elderly, people with chronic health problems (cancer, AIDS, etc.), people in remission from an illness, those taking drugs that weaken the immune system.

Subarachnoid hemorrhage is a disease that remains rare. However, its incidence increases with age.

Diagnosis of meningeal syndrome

Meningeal syndrome is a therapeutic emergency. Faced with the characteristic signs or in the slightest doubt, it is necessary to contact the emergency medical services.

A clinical examination can identify the typical signs of meningeal syndrome. Further testing is needed to identify the underlying cause. The reference examination is the lumbar puncture which consists in taking the cerebrospinal fluid contained in the meninges in order to analyze it. The analysis makes it possible to distinguish between meningitis or subarachnoid hemorrhage.

Other tests can also be done before or after a lumbar puncture:

• brain imaging;
• biological examinations;
• an electroencephalogram.

headaches

Meningeal syndrome is characterized by three main symptoms. The first is the appearance of intense, diffuse and persistent headaches. These are exacerbated during certain movements, in the presence of noise (phonophobia) and in the presence of light (photophobia).

vomiting

The second typical sign of meningeal syndrome is the occurrence of nausea and vomiting.

Muscle stiffness

The manifestation of muscle stiffness is the third typical sign of meningeal syndrome. There is a contracture of the spinal muscles (deep muscles of the dorsal region) which usually causes stiffness in the neck associated with pain radiating to the back.

Other associated signs

The three preceding symptoms are the most typical of meningeal syndrome. However, they can manifest themselves in different ways depending on the case. It is also not uncommon for them to be accompanied by other symptoms such as:

• constipation;
• a feverish state;
• disturbances of consciousness;
• cardiac or respiratory rhythm disturbances.

Management of meningeal syndrome must be systematic and immediate. It requires emergency hospitalization and consists of treating the underlying origin. Treatment for meningeal syndrome may consist of:

• antibiotic treatment for bacterial meningitis;
• antiviral treatment for certain meningoencephalitis of viral origin;
• surgery for aneurysm.

Prevention of meningeal syndrome involves preventing the risk of meningitis and subarachnoid hemorrhage.

With regard to meningitis, the prevention of the risk of infection is based on:

• vaccination, in particular against Haemophilus Influenzae type b;
• hygiene measures to limit the risk of contamination.

With regard to subarachnoid hemorrhage, it is especially advisable to fight against the factors which can promote the development of an intracranial aneurysm. It is therefore advisable to fight against high blood pressure and atheroma (deposit of fat on the wall of the arteries) by maintaining a healthy lifestyle which includes:

• a healthy and balanced diet;
• regular physical activity.